Implantable cardioverter defibrillator for the prevention of sudden cardiac death: Systematic review and pooled analysis

Abstract

Implantable cardioverter defibrillator (ICD) is an innovative biomedical device designed to detect and terminate malignant ventricular arrhythmias (VAs) with convincing evidence of substantial life-saving properties. Its prophylactic use for sudden cardiac death (SCD) in patients resuscitated from cardiac arrest or at risk for malignant VAs has revolutionized the face of clinical care for many cardiac diseases with a shift from antiarrhythmic drugs. Progressive improvements in ICD device has expanded the prophylactic use of ICD to include pre-emptive therapy in a large population of patients with significantly depressed left ventricular systolic function. This expansion increased the incidence of inappropriate shocks potentially affecting treatment efficacy. Moreover, inadequate attention paid to the patient's psychosocial concerns and cost-effectiveness of therapy has affected treatment outcomes as well as quality of life. The knowledge of these complications and challenges is critical for appropriate selection of patients who will benefit from the therapy as well as improve treatment outcomes. The purpose of this literature review and pooled analysis is to summarize the current knowledge base of clinical indications, treatment outcomes, psychosocial concerns and healthcare costs for ICD patients and to identify gaps in ICD literature that would be appropriate targets for future research.